Intolerance: Medicine’s Nemesis

Medical Statue at Semmelweiss Medical Museum
Medical Statue at Semmelweiss Medical Museum (Photo credit: Curious Expeditions)

I had grown up thinking medicine was free of the prejudices, if not sheer ignorance, rampant in the everyday world where resistance to anything new seems a given.  Let’s face it:  we humans don’t like having the security of our assumptions challenged.  The truth is that the history of medicine shows the same proclivity for stubbornness or subordination to the weight of custom as elsewhere.

In his riveting study, Doctors: The Biography of Medicine, physician Sherwin Nulan recounts the story of Ignac Semmelweiss, a young Viennese physician in the 1840s, who observed that women delivering their babies in hospitals died of puerperal, or bed fever, considerably more frequently than those delivering at home.  He did his own research to find out why, ultimately discovering a link between medical student routine and maternal deaths.

Each day,  students and profs would examine cadavers in between visiting patients. Although they didn’t have any notion of germs back then, Semmelweiss ultimately concluded that “invisible cadaver particles” on the hands of students and attending physicians was the source.  In short, he had discovered the role of infection in promoting illness.  

Instituting a protocol of his students’ washing their hands in a chlorine solution, he saw a dramatic drop-off in mortality.  His colleagues, however weren’t amused by this young upstart, whose research implicated them in so many deaths.  Consequently, Semmelweiss didn’t publish his research for fifteen years.

Dr. Joseph Lister
Dr. Joseph Lister

By the 1860s,  Louis Pasteur’s germ theory had entered into medicine, though it initially wasn’t widely accepted.  In Britain, Dr. Joseph Lister decided to apply the notion to post surgical infections, which were nearly always fatal.  Discovering that a neighbor city had poured carbolic acid down its drains to eliminate a potent sewer stench, he concluded that the acid had killed microorganisms similar to those Pasteur had identified.  Applying this concept to surgery, he employed wound dressings saturated in carbolic acid.  Later, he added spraying the entire surgical area with the solution.  Ultimately, he expanded the solution to washing his hands and instruments.  Lister published his successful results in 1867, inaugurating the formal beginnings of antisepsis.  It would be another generation, however, before Lister’s innovations became universal.

It was only in the 1880s that doctors had finally moved beyond a solely antiseptic solution to changing their clothes and boiling their instruments, sutures, towels, and sponges and adopting a ritual of vigorous hand washing.  In 1893,  Dr. William Halsted  became the first surgeon to wear a surgical mask.  In the 1920s, white garments and linens became universal, though the former now seems to be giving way to darker shades again.

Infection still remains a serious threat and the shorter your hospital stay, the better your odds.  Each year, nearly 2 million patients experience infection and 100,000 die.

Even with today’s antibiotics, infection looms as a serious menace, complicated by the increasing rise of resistant, highly contagious bacteria strains.

The bottom line in medicine is that what we don’t know often governs more than what we know.   After several thousand years, we overwhelmingly treat symptoms, not causes.  Now and then, however, a Semmelweiss or Lister appears like some new Columbus, charting a vastly different terrain leading to a New World.  Thus, it behooves medicine to be open to self-scrutiny, forfeit vested authority, tradition, and prejudice.  Only in this way can we find the breakthroughs that advance our safety, promote our healing, and perhaps offer sovereignty over some of our most chronic diseases like cancer.

–rj

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Something worse than global warming?

We hear much about global warming these days, understandable given its smothering consequences for all life on earth.  Unfortunately, humans have at large remained callous to making lifestyle changes that may delay its full onset or lessen its consequences.  Recent research clearly indicts us as primary contributors to climate change in our dependency on fossil fuels.  Last year was the hottest on record.

Bad as the global warming scenario may be, I would argue we face a greater crisis elsewhere, simply because it’s happening right now and we’ve less than 20-years to find a solution.   I’m writing about the exponential increase in resistant microbes.  I don’t mean to push the panic button, but this isn’t a false alarm.

I wish things were otherwise, but an ostrich stance just won’t do.  Like many of you, I’ve read articles, even books, promising  not only the extinction of many of our primary diseases, but the near abolishment of death itself, or at least pervasive longevity.  This optimism, swelled by genetic research, hints at our finding targeted therapies that can prevent, modify, or eliminate diseases like cancer, diabetes, and dementia.  With dietary alterations, we may even speed the healing.

I’ve read recently that it’s essentially only 25-years and we’ll find medicine revolutionized.  Labs will diagnose your genomes and, like today’s culture specimens, suggest a solution.  No more fussing with finding the right medication and risking their frequent side effects.  We sometimes call it “metric” medicine, treatment individually tailored to get at or prevent what may ail you.

Unfortunately, this heaven-on-earth scenario isn’t likely to happen any time soon, given the inveterate increase of microbes resistant to antibiotics.  Again, its threat dwarfs the crisis of global warming.  As Professor Sally Davies, England’s chief medical officer, recently shared with parliament members, “It is clear that we might not ever see global warming; the apocalyptic scenario is that when I need a new hip in 20-years, I’ll die from a routine infection because we’ve run out of antibiotics” (“Antibiotic ‘Apocalypse’ Warning”).  www.bbc.co.uk).

By the way, think twice when it comes to a hospital stay.  Currently between 5 to 10 percent of patients develop an infection.  90,000 of them die, up from 13,300 just back in 1992 (www.medicine.net).  The cost impact of infections is enormous at $20 billion annually and eight million additional hospital days (Centers for Disease Control and Prevention [April 2011]).

Now the World Health Organization warns that we’ve reached a crucial point in the matter of resistant microbes.  Consider the present situation:

Presently we’re down to just two antibiotics for treating MRSA and one of these isn’t very good.  (MRSA now exceeds AIDS in annual U. S. mortality.)

With highly prevalent gonorrhea, we’re just about out of remedy.

And then there are candida, malaria, tuberculosis, staph and even UTI’s, all of them exhibiting increasing insensitivity to antibiotics.

Like global warming, we’ve done a lot of this to ourselves.

1.  Antibiotics are overly prescribed or treatment isn’t fully carried out.

2.  Hospital staff don’t consistently practice good hygiene.

3.  Cattle are fed antibiotics to inhibit disease and encourage growth.

4.  We’re destroying our rainforests, with their potential for new antibiotic substances.

5.  Ubiquitous use of antibacterial soaps and napkins, etc, increasing germ tolerance.

6.  Increased travel to underdeveloped countries, raising the possibility of Superbug contagion.

Matters aren’t helped by the scourge of HIV and TB raging across Africa, largely due to patient mismanagement of medications.  In India, currently, there’s a new Superbug that’s made its appearance, infecting even the water supply in Delhi. Compounding its threat is widespread travel these days, and the bug’s recent appearance in North America.  The sad fact is that exotic diseases are potentially only an air flight away.

This is always the ultimate threat–that somewhere, somehow, a new infection source will emerge for which we haven’t any remedy.  As Dr. Davis Agus reminds  us, even in the context of his best selling The End of Illness (2011) with its vibrant optimism, “The swine flu scare that occurred in 2009 will some day be dwarfed by a real epidemic that will spread rapidly through virgin immune systems and kill millions in its path (as happened, for example, in the flu pandemic of 1918, when an estimated 50 million to 100 million people died” (p. 277).

As I write, a new TB strain has made its appearance in Papua and like AIDS in Africa,  is badly managed.  Experts fear it may soon defy any cure.

Of course there are optimists who argue we’ll come up with treatment solutions.  We always have.

The reality is we’ve very little time and the research isn’t promising.  As Professor Hugh Pennington of the University of Aberdeen bluntly puts it, “We have to be aware that we aren’t going to have new wonder drugs coming along because there just aren’t any.”

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